Anteriorly Based Tongue Flap for Closure of a Posterior Palatal Defect in a Patient with Exaggerated Gag Reflex

Abstract

Background

Closure of palatal fistulas requires meticulous attention to detail as well as
sound understanding of relevant anatomy. Tongue flaps of various design based
on defect location, size and confounding patient factors, have been proven to
be effective in closing intraoral defects.

Case
Description

A 37 year old Hispanic female presented to our hospital with a
palatal pleomorphic adenoma. After initial resection, a split thickness skin
graft was performed to the operative site, and prosthesis was fabricated. The
patient could not tolerate her obturator secondary to a severe gag reflex, and
was left with residual 3x2cm oro-nasal defect.Reconstruction of the defect was planned with the use of an anteriorly
based tongue flap due to concerns that the patient’s severe gag reflex would
make a traditional posteriorly based flap intolerable.

Practical Implications

The purpose of this article
is to describe the options available for closure of an oro-nasal fistula, and
describe our use of an anteriorly based dorsal tongue flap to close a large
posterior soft palate defect in a patient with a severe gag reflex.The exaggerated reflexes might have otherwise
been considered a contraindication.